The effectiveness of coronary computed tomography angiography and functional testing for the diagnosis of obstructive coronary artery disease: results from the individual patient data Collaborative Meta-Analysis of Cardiac CT (COME-CCT).

IF 4.1 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Peter Schlattmann, Viktoria Wieske, Keno K Bressem, Theresa Götz, Georg M Schuetz, Daniele Andreini, Gianluca Pontone, Hatem Alkadhi, Jörg Hausleiter, Elke Zimmermann, Bernhard Gerber, Abbas A Shabestari, Matthijs F L Meijs, Akira Sato, Kristian A Øvrehus, Shona M M Jenkins, Juhani Knuuti, Ashraf Hamdan, Bjørn A Halvorsen, Vladimir Mendoza-Rodriguez, Johannes Rixe, Yung-Liang Wan, Christoph Langer, Sebastian Leschka, Eugenio Martuscelli, Said Ghostine, Jean-Claude Tardif, Alejandra Rodríguez Sánchez, Robert Haase, Marc Dewey
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引用次数: 0

Abstract

Aim: To determine the effectiveness of functional stress testing and computed tomography angiography (CTA) for diagnosis of obstructive coronary artery disease (CAD).

Methods and results: Two-thousand nine-hundred twenty symptomatic stable chest pain patients were included in the international Collaborative Meta-Analysis of Cardiac CT consortium to compare CTA with exercise electrocardiography (exercise-ECG) and single-photon emission computed tomography (SPECT) for diagnosis of CAD defined as ≥ 50% diameter stenosis by invasive coronary angiography (ICA) as reference standard. Generalised linear mixed models were used for calculating the diagnostic accuracy of each diagnostic test including non-diagnostic results as dependent variables in a logistic regression model with random intercepts and slopes. Covariates were the reference standard ICA, the type of diagnostic method, and their interactions. CTA showed significantly better diagnostic performance (p < 0.0001) with a sensitivity of 94.6% (95% CI 92.7-96) and a specificity of 76.3% (72.2-80) compared to exercise-ECG with 54.9% (47.9-61.7) and 60.9% (53.4-66.3), SPECT with 72.9% (65-79.6) and 44.9% (36.8-53.4), respectively. The positive predictive value of CTA was ≥ 50% in patients with a clinical pretest probability of 10% or more while this was the case for ECG and SPECT at pretest probabilities of ≥ 40 and 28%. CTA reliably excluded obstructive CAD with a post-test probability of below 15% in patients with a pretest probability of up to 74%.

Conclusion: In patients with stable chest pain, CTA is more effective than functional testing for the diagnosis as well as for reliable exclusion of obstructive CAD. CTA should become widely adopted in patients with intermediate pretest probability.

Systematic review registration: PROSPERO Database for Systematic Reviews-CRD42012002780.

Critical relevance statement: In symptomatic stable chest pain patients, coronary CTA is more effective than functional testing for diagnosis and reliable exclusion of obstructive CAD in intermediate pretest probability of CAD.

Key points: Coronary computed tomography angiography showed significantly better diagnostic performance (p < 0.0001) for diagnosis of coronary artery disease compared to exercise-ECG and SPECT. The positive predictive value of coronary computed tomography angiography was ≥ 50% in patients with a clinical pretest probability of at least 10%, for ECG ≥ 40%, and for SPECT 28%. Coronary computed tomography angiography reliably excluded obstructive coronary artery disease with a post-test probability of below 15% in patients with a pretest probability of up to 74%.

冠状动脉计算机断层扫描血管造影和功能测试诊断阻塞性冠状动脉疾病的有效性:心脏计算机断层扫描(COME-CCT)个体患者数据协作元分析的结果。
目的:确定功能性压力测试和计算机断层扫描血管造影(CTA)诊断阻塞性冠状动脉疾病(CAD)的有效性:国际心脏 CT 协作元分析联盟纳入了 292 名无症状稳定型胸痛患者,比较 CTA 与运动心电图(exercise-ECG)和单光子发射计算机断层扫描(SPECT)在诊断以有创冠状动脉造影(ICA)为参考标准的直径≥ 50%狭窄的 CAD 方面的效果。在随机截距和斜率的逻辑回归模型中,使用广义线性混合模型计算每种诊断测试的诊断准确性,包括作为因变量的非诊断结果。协变量包括参考标准 ICA、诊断方法类型及其交互作用。CTA 的诊断效果明显更好(P对于稳定型胸痛患者,CTA 在诊断和可靠排除阻塞性 CAD 方面比功能检测更有效。CTA 应广泛应用于检测前概率中等的患者:系统综述注册:PROSPERO 系统综述数据库-CRD42012002780.关键相关性声明:在有症状的稳定型胸痛患者中,冠状动脉计算机断层扫描(CTA)比功能检查更有效,可诊断并可靠地排除阻塞性 CAD 的中度预检概率:要点:冠状动脉计算机断层扫描血管造影术的诊断效果明显更好(p
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来源期刊
Insights into Imaging
Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
7.30
自引率
4.30%
发文量
182
审稿时长
13 weeks
期刊介绍: Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.
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